Posts filed under ‘Infecciones virales’

Avian Influenza A(H7N2) Virus in Human Exposed to Sick Cats, New York, USA, 2016

Emerging Infectious Diseases December 2017 V.23 N.12

Atanaska Marinova-Petkova, Jen Laplante, Yunho Jang, Brian Lynch, Natosha Zanders, Marisela Rodriguez, Joyce Jones, Sharmi Thor, Erin Hodges, Juan A. De La Cruz, Jessica Belser, Hua Yang, Paul Carney, Bo Shu, LaShondra Berman, Thomas Stark, John Barnes, Fiona Havers, Patrick Yang, Susan C. Trock, Alicia Fry, Larisa Gubareva, Joseph S. Bresee, James Stevens, Demetre Daskalakis, Dakai Liu, Christopher Lee, Mia Kim Torchetti, Sandra Newbury, Francine Cigel, Kathy Toohey-Kurth, Kirsten St. George, David E. Wentworth, Stephen Lindstrom, and C. Todd Davis

Author affiliations:

Centers for Disease Control and Prevention, Atlanta, Georgia, USA (A. Marinova-Petkova, Y. Jang, B. Lynch, N. Zanders, M. Rodriguez, J. Jones, S. Thor, E. Hodges, J.A. De La Cruz, J. Belser, H. Yang, P. Carney, B. Shu, L. Berman, T. Stark, J. Barnes, F. Havers, P. Yang, S.C. Trock, A. Fry, L. Gubareva, J.S. Bresee, J. Stevens, D.E. Wentworth, S. Lindstrom, C.T. Davis); New York State Department of Health, Albany, New York, USA (J. Laplante, K. St. George); New York City Department of Health and Mental Hygiene, Long Island City, New York, USA (D. Daskalakis, D. Liu, C.T. Lee); US Department of Agriculture, Ames, Iowa, USA (M.K. Torchetti); University of Wisconsin, Madison, Wisconsin, USA (S. Newbury, F. Cigel, K. Toohey-Kurth)

An outbreak of influenza A(H7N2) virus in cats in a shelter in New York, NY, USA, resulted in zoonotic transmission. Virus isolated from the infected human was closely related to virus isolated from a cat; both were related to low pathogenicity avian influenza A(H7N2) viruses detected in the United States during the early 2000s.

PDF

https://wwwnc.cdc.gov/eid/article/23/12/pdfs/17-0798.pdf

 

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December 4, 2017 at 8:14 am

IDSA/AASLD Response to Cochrane Review on Direct-Acting Antivirals for Hepatitis C

Clinical Infectious Diseases December 2017 V.65 N.11

EDITOR’S CHOICE

William G Powderly; Susanna Naggie; Arthur Y Kim; Hugo E Vargas; Raymond T Chung …

A recent Cochrane Review with the stated objective to assess the benefits and harms of direct-acting antiviral (DAA) therapy for people with chronic hepatitis C virus (HCV) infection raised alarms within the hepatology and infectious diseases communities because the authors concluded that there was insufficient evidence to confirm or reject an effect of DAA therapy on HCV-related morbidity (cirrhosis, hepatic decompensation, or hepatocellular carcinoma) or all-cause mortality [1]. The authors also concluded that the clinical relevance of sustained virological response (SVR) obtained with DAAs is questionable, as it is a nonvalidated surrogate outcome. The Review further stated that because all DAA trials and outcome results were at high risk of bias, their results presumably overestimated benefit and underestimated harm. Indeed, the plain language summary stated that the lack of valid evidence and the possibility of potentially harming people with chronic hepatitis should be considered before treating people with hepatitis C using DAAs. Based on the findings of this Review, the authors concluded that additional randomized clinical trials are needed to assess the long-term clinical effects of DAAs…

PDF (hacer CLIC en PDF)

https://academic.oup.com/cid/article/65/11/1773/3965298

November 29, 2017 at 8:21 am

Fiebre de origen desconocido en pacientes HIV positivos

ANALES DE MEDICINA INTERNA (Madrid), 2001 V.18 N.4 P.181-186

BARBA, J. GÓMEZ-RODRIGO, J. MARCO, P. RONDÓN, G. EROLES,

LÓPEZ-VARAS, R. TORRES

Departamento de Medicina Interna y Enfermedades Infecciosas. Hospital Severo Ochoa.

Leganés. Madrid

RESUMEN

Objetivos

Describir la presentación clínica y la utilidad de los de tests diagnósticos habitualmente recomendados en el estudio de la fiebre de origen desconocido (FOD) en los pacientes VIH positivos.

Pacientes y métodos

Incluimos en el estudio a los 54 pacientes con infección por el VIH que ingresaron en nuestro Hospital por FOD durante un periodo de 23 meses. La FOD fue definida de acuerdo con los criterios modificados de Petersdorf´s.

Resultados

La causa de la fiebre se identificó en 48 casos (89%). La tuberculosis, la micobacteriosis atípica y la leishmaniasis pueden explicar el 68% de los casos. El aspirado de médula ósea, la punción aspiración o la biopsia de los ganglios linfáticos y los cultivos para micobacterias fueron las pruebas diagnósticas más rentables.

Conclusiones

La infección por micobacterias debe ser el primer diagnóstico de sospecha en los pacientes VIH positivos con FOD. Es posible precedir el diagnóstico de tuberculosis con una alta precisión (90,5%) con un modelo de regresión logística basado en datos clínicos y analíticos fácilmente obtenibles.

PDF

http://scielo.isciii.es/pdf/ami/v18n4/original2.pdf

November 21, 2017 at 8:41 am

FIEBRE DE ORIGEN DESCONOCIDO EN PACIENTES INFECTADOS CON EL VIRUS DE LA INMUNODEFICIENCIA HUMANA

MEDICINA (Buenos Aires) 2000 V.60 N.5 P.623-630

SEBASTIAN A. MATHURIN, SERGIO LUPO, HECTOR O. ALONSO

Primera Cátedra de Clínica Médica y Terapéutica, Facultad de Ciencias Médicas, Universidad Nacional de Rosario; Hospital Provincial del Centenario, Rosario

La fiebre de origen desconocido (FOD) es frecuente en pacientes infectados por el HIV. Existen numerosas causas que pueden originar FOD y su frecuencia relativa depende de múltiples factores. Usualmente se debe a una infección oportunista agregada.

La evaluación diagnóstica depende de la presentación clínica y del estadio de la infección por HIV. Existe una asociación entre el recuento de linfocitos CD4 y ciertas enfermedades oportunistas que pueden originar FOD.

El área geográfica y la prevalencia local de infecciones endémicas es un factor importante. Las infecciones de distribución mundial como la tuberculosis siempre deben ser consideradas y otras como la histoplasmosis diseminada son causa frecuente de FOD en áreas endémicas como la Argentina.

La mayor utilidad diagnóstica se obtiene con los cultivos de esputo y hemocultivos para micobacterias, y entre los métodos invasivos con cultivos a partir de la aspiración/biopsia de ganglio linfático, la biopsia de médula ósea y la biopsia hepática.

La eficacia del tratamiento empírico ha sido documentada en ciertas infecciones.

FULL TEXT

http://www.medicinabuenosaires.com/revistas/vol60-00/5-1/fiebredeorigen.htm

November 21, 2017 at 8:34 am

HIV-1 persistence following extremely early initiation of antiretroviral therapy (ART) during acute HIV-1 infection: An observational study.

PLoS Med November 7, 2017 V.14 P.e1002417.

Henrich TJ et al.

Abstract

Background

It is unknown if extremely early initiation of antiretroviral therapy (ART) may lead to long-term ART-free HIV remission or cure. As a result, we studied 2 individuals recruited from a pre-exposure prophylaxis (PrEP) program who started prophylactic ART an estimated 10 days (Participant A; 54-year-old male) and 12 days (Participant B; 31-year-old male) after infection with peak plasma HIV RNA of 220 copies/mL and 3,343 copies/mL, respectively. Extensive testing of blood and tissue for HIV persistence was performed, and PrEP Participant A underwent analytical treatment interruption (ATI) following 32 weeks of continuous ART.

Methods and findings

Colorectal and lymph node tissues, bone marrow, cerebral spinal fluid (CSF), plasma, and very large numbers of peripheral blood mononuclear cells (PBMCs) were obtained longitudinally from both participants and were studied for HIV persistence in several laboratories using molecular and culture-based detection methods, including a murine viral outgrowth assay (mVOA). Both participants initiated PrEP with tenofovir/emtricitabine during very early Fiebig stage I (detectable plasma HIV-1 RNA, antibody negative) followed by 4-drug ART intensification. Following peak viral loads, both participants experienced full suppression of HIV-1 plasma viremia. Over the following 2 years, no further HIV could be detected in blood or tissue from PrEP Participant A despite extensive sampling from ileum, rectum, lymph nodes, bone marrow, CSF, circulating CD4+ T cell subsets, and plasma. No HIV was detected from tissues obtained from PrEP Participant B, but low-level HIV RNA or DNA was intermittently detected from various CD4+ T cell subsets. Over 500 million CD4+ T cells were assayed from both participants in a humanized mouse outgrowth assay. Three of 8 mice infused with CD4+ T cells from PrEP Participant B developed viremia (50 million input cells/surviving mouse), but only 1 of 10 mice infused with CD4+ T cells from PrEP Participant A (53 million input cells/mouse) experienced very low level viremia (201 copies/mL); sequence confirmation was unsuccessful. PrEP Participant A stopped ART and remained aviremic for 7.4 months, rebounding with HIV RNA of 36 copies/mL that rose to 59,805 copies/mL 6 days later. ART was restarted promptly. Rebound plasma HIV sequences were identical to those obtained during acute infection by single-genome sequencing. Mathematical modeling predicted that the latent reservoir size was approximately 200 cells prior to ATI and that only around 1% of individuals with a similar HIV burden may achieve lifelong ART-free remission. Furthermore, we observed that lymphocytes expressing the tumor marker CD30 increased in frequency weeks to months prior to detectable HIV-1 RNA in plasma. This study was limited by the small sample size, which was a result of the rarity of individuals presenting during hyperacute infection.

Conclusions

We report HIV relapse despite initiation of ART at one of the earliest stages of acute HIV infection possible. Near complete or complete loss of detectable HIV in blood and tissues did not lead to indefinite ART-free HIV remission. However, the small numbers of latently infected cells in individuals treated during hyperacute infection may be associated with prolonged ART-free remission.

FULL TEXT

http://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1002417

PDF

http://journals.plos.org/plosmedicine/article/file?id=10.1371/journal.pmed.1002417&type=printable

 

 

November 21, 2017 at 7:27 am

Follow-up brain imaging of 37 children with congenital Zika syndrome: Case series study

BMJ 2017 Oct 13; 359:j4188

Calheiros de Lima Petribu N et al.

Abstract

Objective

To compare initial brain computed tomography (CT) scans with follow-up CT scans at one year in children with congenital Zika syndrome, focusing on cerebral calcifications.

Design

Case series study.

Setting

Barão de Lucena Hospital, Pernambuco state, Brazil.

Participants

37 children with probable or confirmed congenital Zika syndrome during the microcephaly outbreak in 2015 who underwent brain CT shortly after birth and at one year follow-up.

Main outcome measure

Differences in cerebral calcification patterns between initial and follow-up scans.

Results

37 children were evaluated. All presented cerebral calcifications on the initial scan, predominantly at cortical-white matter junction. At follow-up the calcifications had diminished in number, size, or density, or a combination in 34 of the children (92%, 95% confidence interval 79% to 97%), were no longer visible in one child, and remained unchanged in two children. No child showed an increase in calcifications. The calcifications at the cortical-white matter junction which were no longer visible at follow-up occurred predominately in the parietal and occipital lobes. These imaging changes were not associated with any clear clinical improvements.

Conclusion

The detection of cerebral calcifications should not be considered a major criterion for late diagnosis of congenital Zika syndrome, nor should the absence of calcifications be used to exclude the diagnosis.

FULL TEXT

http://www.bmj.com/content/359/bmj.j4188

PDF

http://www.bmj.com/content/bmj/359/bmj.j4188.full.pdf

 

November 16, 2017 at 8:12 am

Eliminating viral hepatitis: time to match visions with action

Lancet  November 11, 2017  V.390 N.10.108 P.2121

EDITORIAL

Eliminating viral hepatitis: time to match visions with action

 

PDF

http://thelancet.com/pdfs/journals/lancet/PIIS0140-6736(17)32856-8.pdf

 

 

November 10, 2017 at 4:02 pm

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